Effect of fluid and sodium removal on mortality in peritoneal dialysis patients

Ateş, Kenan; Nergızoğlu, Gökhan; Keven, Kenan; Sen, Arzu; Kutlay, Sim; Ertürk, Şehsuvar; Duman, Neval; Karatan, Oktay; Ertug, A. E.

doi:10.1046/j.1523-1755.2001.060002767.x

Cited by 338 publications

(285 citation statements)

References 26 publications

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“…Whatever the explanation, this study suggests that clinicians need to pay close attention to APD patients who consistently achieve low UF volumes. This observation is in keeping with those from other recent studies, such as Ates et al (39), which suggested that the impact of loss of residual renal function on survival was due to its effect on salt and water removal and not the loss of small solute clearance.…”

Section: Discussionsupporting

confidence: 92%

Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

Brown¹,

Davies²,

Rutherford³

et al. 2003

Journal of the American Society of Nephrology

346

311

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Abstract. The European APD Outcome Study (EAPOS) is a 2-yr, prospective, multicenter study of the feasibility and clinical outcomes of automated peritoneal dialysis (APD) in anuric patients. A total of 177 patients were enrolled with a median age of 54 yr (range, 21 to 91 yr). Previous median total time on dialysis was 38 mo (range, 1.6 to 259 mo), and 36% of patients had previously been on hemodialysis for Ͼ90 d. Diabetes and cardiovascular disease were present in 17% and 46% of patients, respectively. The APD prescription was adjusted at physician discretion to aim for creatinine clearance (Ccrea) Ն60 L/wk per 1.73 m 2 and ultrafiltration (UF) Ն750 ml/24 h during the first 6 mo. Baseline solute transport status (D/P) was determined by peritoneal equilibration test. At 1 yr, 78% and 74% achieved Ccrea and UF targets, respectively; median drained dialysate volume was 16.2 L/24 h with 50% of patients using icodextrin. Baseline D/P was not related to UF achieved at 1 yr. At 2 yr, patient survival was 78% and technique survival was 62%. Baseline predictors of poor survival were age (Ͼ65 yr; P ϭ 0.006), nutritional status (Subjective Global Assessment grade C; P ϭ 0.009), diabetic status (P ϭ 0.008), and UF (Ͻ750 ml/24 h; P ϭ 0.047). Time-averaged analyses showed that age, Subjective Global Assessment grade C and diabetic status predicted patient survival with UF the next most significant variable (risk ratio, 0.5/L per d; P ϭ 0.097). Baseline Ccrea, time-averaged Ccrea, and baseline D/P had no effect on patient or technique survival. This study shows that anuric patients can successfully use APD. Baseline UF, not Ccrea or membrane permeability, is associated with patient survival.

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Section: Discussionsupporting

confidence: 92%

Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

Brown¹,

Davies²,

Rutherford³

et al. 2003

Journal of the American Society of Nephrology

346

311

View full text Add to dashboard Cite

show abstract

“…These peritoneal changes, coupled with loss of residual renal function, probably underlie the high prevalence of volume overload seen in many PD patients. Several studies (63)(64)(65) have shown an inverse relationship between daily peritoneal ultrafiltration volume and mortality, data that are consistent with the notion that reduced ultrafiltration capacity and consequent hypervolemia with increasing dialysis vintage may reverse the early survival advantage with PD.…”

Section: Possible Biologic Explanations For Differences In Outcomes Bsupporting

confidence: 60%

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Khawar

Kalantar-Zadeh

et al. 2007

Clinical Journal of the American Society of Nephrology

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In the past decade, peritoneal dialysis use among patients with end-stage renal disease has declined in many countries. Studies from the United States indicate that many academic centers do not have adequate resources to train fellows, most incident dialysis patients are not offered peritoneal dialysis, and more than half of dialysis clinics do not have the infrastructure to support peritoneal dialysis. Some are concerned that the outcomes of peritoneal dialysis and maintenance hemodialysis patients may not be equivalent, a notion that is not supported by outcome studies. Given the effect of modality selection on patients' lifestyle, attempts to conduct a randomized, controlled comparison of maintenance hemodialysis and peritoneal dialysis have been unsuccessful. Most observational studies showed that peritoneal dialysis is associated with a survival advantage that diminishes over time; it is unclear whether any of the differences over time are attributable to the modality. Between 1996 and 2003, the early outcomes of peritoneal dialysis patients further improved, whereas those for maintenance hemodialysis patients remained unchanged. Differences in outcomes may be due to residual statistical confounding; however, several biologic mechanisms can be postulated: The early survival advantage may be related to the better preservation of residual renal function with peritoneal dialysis, and the diminution of the survival advantage may be related to worsened volume control. There is a need for large observational and interventional studies among peritoneal dialysis patients to sustain and enforce the improvements in both dialysis therapies.

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“…Hypervolemia is an important predictor of morbidity and mortality in PD patients (34). On the other hand, we did not find a correlation of endothelial dysfunction with residual renal functions, total fluid removal, and dialysis adequacy parameters.…”

Section: Discussioncontrasting

confidence: 86%

Flow-Mediated Dilatation and Asymmetric Dimethylarginine Do Not Predict Mortality in Peritoneal Dialysis Patients

Uzun¹,

Karadağ²,

Gürsu³

et al. 2017

Haseki

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Akım Aracılı Dilatasyon ve Asimetrik Dimetilargi Periton Diyalizi Hastalarında Mortalite Prediktörü DeğildirAim: Asymmetric dimethylarginine (ADMA) is associated with increased coronary artery disease risk through endothelial dysfunction in dialysis patients. We aimed to investigate the role of flow-mediated dilatation (FMD), a non-invasive indicator of endothelial function, and ADMA in mortality in peritoneal dialysis (PD) patients.Methods: PD patients aged 18-80 years; with dialysis duration of at least three months were included. FMD measurement and ADMA levels were recorded. Outcome of the patients on the third year were analyzed with binary logistic analyses. Results:The mean age of the 55 patients was 53±15 years and the mean follow-up duration was 36 months. Mean FMD and ADMA levels were 10.6±6.4% and 81.8±48.0 mol/L, respectively. Eighteen patients died during follow-up. Age, presence of diabetes mellitus and ischemic heart disease, ultrafiltration amount and serum albumin level were related with mortality while gender, weekly Kt/V and ADMA levels were not. There was no significant relationship between ADMA level and FMD (p=0.873). FMD was negatively correlated with systolic and diastolic blood pressures (p=0.001, p<0.001, respectively). Hypertension was found to be the most important single factor determining FMD (p=0.037). Conclusion:Estimating endothelial function by FMD or measuring serum ADMA levels may not be useful for predicting mortality in PD patients.Keywords: Flow mediated dilatation, asymmetric dimethylarginine, endothelial dysfunction, peritoneal dialysis, mortality Amaç: Diyaliz hastalarında asimetrik dimetilarginin (ADMA) endotel disfonksiyonu yoluyla artmış koroner arter hastalığı riski ile ilişkilidir. Bu çalışmada periton diyalizi (PD) hastalarında endotel disfonksiyonunun non-invaziv bir göstergesi olan akım aracılı dilatasyon (AAD) ve ADMA'nın mortalite ile ilişkisini araştırmayı amaçladık.Yöntemler: Çalışmaya 18-80 yaş aralığında, en az üç aydır diyaliz uygulanan PD hastaları dahil edildi. AAD ölçümü ve ADMA düzeyleri kaydedildi. Üçüncü yılda hasta sonlanımlarında "binary lojistik analizi" kullanıldı.Bulgular: Çalışmaya dahil edilen 55 hastanın yaş ortalaması 53±15 yıl, ortalama takip süresi 36 ay idi. Ortalama AAD ve ADMA düzeyleri sırasıyla %10,6±6,4 ve 81,8±48,0 mol/L idi. On sekiz hasta takip sırasında öldü. Yaş, diyabet ve iskemik kalp hastalığı varlığı, ultrafiltrasyon miktarı ve serum albümin düzeyleri mortalite ile ilişkili iken cinsiyet, haftalık Kt/V ve ADMA düzeyleri ilişkili değildi. ADMA düzeyleri ve AAD arasında anlamlı ilişki yoktu (p=0,873). AAD ile klinik parametrelerden sistolik ve diastolik kan basıncı arasında anlamlı negatif korelasyon vardı (p=0,001, p<0,001). Tüm parametreler arasında AAD'yi belirleyen en önemli tek faktör hipertansiyondu (p=0,037).Sonuç: AAD ile endotel fonksiyonunun değerlendirilmesi veya serum ADMA düzeylerinin ölçülmesi periton diyalizi hastalarında mortaliteyi tahmin etmek için yararlı olmayabilir.

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Effect of fluid and sodium removal on mortality in peritoneal dialysis patients

Abstract: Together, these findings suggest that removal of sodium and fluid is a predictor of mortality in PD patients, whereas Kt/V(urea) and TCC are not factors. Adequate fluid and sodium balance is crucial for the management of patients on PD.

Cited by 338 publications

References 26 publications

Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Flow-Mediated Dilatation and Asymmetric Dimethylarginine Do Not Predict Mortality in Peritoneal Dialysis Patients

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